Drug seekers

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I'm sure this has been posted before and I would appreciate any links to good threads on the topic. I am a new nurse and struggle with giving strong opiates like Dilaudid, etc to people who are clearly pain seeking. I feel dirty. Yesterday I had a gentleman who was ordered 1mg Q6. He was a clock watcher. As soon as that six hours was up, he was on the light. The reason he was getting this is because during the previous shift he threw such a fit yelling, screaming etc to have it the physician ordered it. Looking through his history, this is his pattern. Usually in the ER he yells and screams and demands IV Dilaudid. In this country there are a lot of people addicted to opiates because they are often over prescribed and these types of things feeds into that. As a nurse, one of our responsibilities is to encourage health and I feel more like I am contributing to a societal problem than helping a patient in situations such as this.

I don't want this to be a "pain is what the patient says it is" argument. I am talking about the rare instances where someone is clearly a drug-seeker.

So you are promoting punishing a patient for certain behaviors. WOW

I don't condone that behavior, but I'm not really sure why you find it so shocking. A lot of nurses do this, some more subtly than others.

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So you are promoting punishing a patient for certain behaviors. WOW

For a patient only seeking drugs and clearly not in pain, I don't consider such an action to be "punishment," nor does punishing a patient have any place in nursing.

If a patient wants drugs for the sake of getting a "high," they can wait. If the patient is legitimately in pain, there are actions we can take to ensure that the patient is as pain-free as possible. This thread is about drug seekers, not the patients that are legitimately in pain, so my contribution in this thread relates to drug seekers only.

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I don't condone that behavior, but I'm not really sure why you find it so shocking. A lot of nurses do this, some more subtly than others.

But there is a difference between not condoning it, and actually promoting it. Heck yeah I've held off a PRN med for 20 minutes or so due to beligerence. So I think, "Fine. So and so is REALLY needing her meds right now, so I'm going to get to her first. Then beligerence pt. But I wouldn't actually promote doing that.

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For a patient only seeking drugs and clearly not in pain, I don't consider such an action to be "punishment," nor does punishing a patient have any place in nursing.

If a patient wants drugs for the sake of getting a "high," they can wait. If the patient is legitimately in pain, there are actions we can take to ensure that the patient is as pain-free as possible. This thread is about drug seekers, not the patients that are legitimately in pain, so my contribution in this thread relates to drug seekers only.

Ahhh I can see where you are coming from with strictly drug seekers. But as the thread has led in multiple directions, I was not aware you were speaking of, for example, the pt who comes to to the ED doing everything to get narcs.

So I can understand doing that to beligerence patients who truly ARE drug seeking. Nope, you have to wait. I have other patients with real needs to attend to first.

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Specializes in Hospice.

Just be aware that this is also how people with chronic severe pain get trained to act like "drug-seekers". Beware the self-fulfilling prophecy.

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For a patient only seeking drugs and clearly not in pain, I don't consider such an action to be "punishment," nor does punishing a patient have any place in nursing.

If a patient wants drugs for the sake of getting a "high," they can wait. If the patient is legitimately in pain, there are actions we can take to ensure that the patient is as pain-free as possible. This thread is about drug seekers, not the patients that are legitimately in pain, so my contribution in this thread relates to drug seekers only.

Ah, but the OP states that the patient in question has untreated HIV and is a diabetic. So again (and not trying to sound like a broken record) this patient would not be under the heading of not being in pain.

And to me, Q6hr. 1mg dilaudid doses, along with a couple of Percocet, is not an ideal solution.

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People in CHRONIC pain don't necessarily "APPEAR" to be in pain the way someone with recent onset, acute pain does. How many times does this have to be said? Are nursing schools not teaching this anymore?

If I were in pain, whether chronic or acute, I would damn sure be asking for it the minute I could. If you notice this happening, it's a good sign that their pain med regimen might need some tweaking, because it's not holding them for the entire interval.

Knowing what I know about the passive aggressive actions and judgmental attitudes some nurses have about pain medicine, I'd be tempted to discuss SCHEDULED pain meds with a doc if I or a family member was in this situation.

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Specializes in critical care.

Forgive me if this has been mentioned. I need to go to work and I've only read the first two pages.

1 mg dilaudid and a Percocet or two are not going to do much of anything for an addict. They're likely used to taking much more than that. If anything, you might see this person having mild withdraw on such low doses.

Add me to the list of people with pain you'll never see. My spine is broken at L5 and has slipped forward 50%. A girl's gotta work.

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Specializes in Critical Care and ED.

This X 1000

People in CHRONIC pain don't necessarily "APPEAR" to be in pain the way someone with recent onset, acute pain does. How many times does this have to be said? Are nursing schools not teaching this anymore?

If I were in pain, whether chronic or acute, I would damn sure be asking for it the minute I could. If you notice this happening, it's a good sign that their pain med regimen might need some tweaking, because it's not holding them for the entire interval.

Knowing what I know about the passive aggressive actions and judgmental attitudes some nurses have about pain medicine, I'd be tempted to discuss SCHEDULED pain meds with a doc if I or a family member was in this situation.

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Specializes in Critical Care and ED.

I'll never forget the time I ended up in the ED with terrible pelvic and back pain. I couldn't walk and I had no idea what was wrong with me. The first time they treated me like dirt and sent me home with nothing in an ambulance, even though I never even asked for pain meds. When they got me home I could not get out of the ambulance so they brought me back to the hospital where the nurses, including the charge nurse, ridiculed me and made me feel like an inconvenience. Several years later it happened again after a long time of mysterious pain. I went to the ED again straight from work because I could not stand. They gave me Dialudid and I had an MRI which came back negative. Immediately the tone changed and I was treated like absolute dirt. I will never forget that feeling of utter shame, even though again I never asked for any pain meds. I was disgusted and told the nurse in charge how I was made to feel. Months later I was diagnosed with Stage 4 endometriosis with deep infiltrating disease that I needed 3 surgeries for. I still need narcotics and I still work full time. Someone's pain is NOT your decision. Someone's addiction is NOT your concern. Do your job, act like a professional and be an advocate for the patient and try to have some compassion about what people have to go through. I hope it never happens to you so you never get to experience it first hand. Since then I have made it a point of never leaving my patients in pain for any length of time. I make it a priority to give patients their pain meds and if I see someone procrastinating for no good reason I'll give them hell. I do not want to see what happened to me happen to anyone else.

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Specializes in School Nursing, Hospice,Med-Surg.

If my patient asks for their pain med and it is time, their V/S allows for said pain med, I will administer this med as quickly as possible leaving all judgment aside...it doesn't really matter whether I think their pain is true, if they're talking on their cell phone or writhing in pain on their hospital bed.

It makes me really sick to think there's a nurse out there holding a pain med for a few extra minutes just because he/she personally believes a patient doesn't deserve the med the physician has ordered. Disgusting.

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If my patient asks for their pain med and it is time, their V/S allows for said pain med, I will administer this med as quickly as possible leaving all judgment aside...it doesn't really matter whether I think their pain is true, if they're talking on their cell phone or writhing in pain on their hospital bed.

It makes me really sick to think there's a nurse out there holding a pain med for a few extra minutes just because he/she personally believes a patient doesn't deserve the med the physician has ordered. Disgusting.

I believe that is an abuse of power. Nurses have the power to ignore a patient's request under the guise of "nursing judgment." It's inappropriate. If there is a genuine issue with the patient getting too much pain medicine or the interval needs to be addressed, that is the time to have a conversation with the physician or to request a referral to a pain management professional. It's not right for us to stick it to the patient because we have a problem putting distance between our personal feelings and our professional role.

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